| NPI | 1831321645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 982-132) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 438-121) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2009-08-12 |